Friday, 27 March 2009

The aids-epidemic in Africa: the pope is (partly) right

The pope may not be right all the time, according to Luc Bonneux (epidemiologist), but he has a point when he criticises the blind faith in condoms with which we are trying to tackle the African aids-epidemic:

'To my great amazement there are six Belgian parties that are going to ask the pope for an explanation. As if the man is going to take much notice of that. Belgian politics is the synonym for ridicule in the world at the moment… The faith in condoms is only there to be used by the white humanitarian worker. I will repeat the difficult facts… Epidemiology knows a difference between theoretical and practical efficacy. Condoms over steal dildos in a lab work a treat, but over the excited flesh of inexperienced couples there is a lot that goes wrong. Condoms have never been good contraceptives. The chance of becoming pregnant is 6% after one year. If one can become pregnant, one can get HIV. In experienced couples in steady relationships where the man is HIV-positive through contaminated blood-products there is a chance of 1% that the female partner becomes positive after 1 year of consistent condom use. Add a little alcohol, lack of experience, more hormones than common sense, and the chance to be contaminated will increase to several percents. Linking safe sex to condoms is, excuse the word, dangerous claptrap.

Epidemiology also knows a difference between population-strategy and high-risk strategy. With a high-risk strategy a limited group with a big problem is singled out. That in itself means very little for the whole population because the little group is necessarily a minority. The whole of the population only benefits with a population strategy. Condoms are useful for high-risk groups, certainly prostitutes. A healthy sexual way of life, graphically summarised by Mieke Vogels (Green politician) as ‘first blabla, then boomboom’, is good for the whole population.

The first articles on the aids-epidemic in Africa were published 26 years ago. Since then we have seen no evidence of substantial influence on that aids-epidemic. That is partly due to the fact that science has been replaced by ideology. While the moral arrogance of the ayatollahs forces the pope’s to fade, science has failed in showing any effects of condoms on the epidemic. That is not because of a lack of possibilities: the effect of circumcision has been shown. Why did HIV not spread through the whole population anywhere outside Africa? HIV spreads through trios: a contaminated partner is needed to get it and a second partner is necessary to transmit the virus. No trio, no transmission: HIV spreads only by multiple, simultaneous sexual partnerships, not by monogamy and hardly by serial monogamy (successive partners).

Sex with multiple partners at the same time and sex which crosses the generations is the motor of the epidemic in Africa. Young women are financially supported by ‘rich uncles’, promiscuous businessmen, in exchange for sex. That supplies murderous dynamics. Elsewhere experimental youths are protected by their youth, but not in Africa. Those ‘rich uncles’ sow the virus in youth communities and there it spreads through simultaneous partnerships. African women contaminate themselves primarily through steady partnerships. In that kind of relationships condoms are not used, partly because women like to become pregnant. The driving force behind the heterosexual epidemic in Africa is not really a shortage of condoms. Women there are the victim of adultery and ‘rich uncle’-pimps. African women find that as great as you, but they have no choice. African men are like you monogamous with a liking to adultery, if they can get away with it. The drama is that African men get away with it because of the lack of women-rights. A Catholic pope as moral authority has a lot to say about that.

The pope is terribly mistaken when he equals sex to procreation. Where children no longer die the woman is condemned by too high fertility. Intimate sex is a unique aspect of the human species, the carrier of monogamous relationships. Loving sex creates a powerful bond between the parents and through that protects their children. With their disgusting stand against loving sex successive popes haven lost a lot of moral credit in confusing times. But poor and unschooled people find worthiness and hope in religion. HIV-prevention must make a coalition with moral leaders. Experience in life is needed to choose a life partner, and so we must not start on sex too early. It is unhealthy to have sex as recreational sport, or to cheat on one’s partner. Whoever contaminates his wife through adultery is a bastard, whoever misuses his power to force young girls to sex is a pig. That goes here and in Africa. It is astonishing and sad that 26 years ago, that simple, clear, human message, supported by everyone with leadership, would have been able to prevent millions of transmissions.'

I suppose the article speaks for itself… Change the culture of adultery and how women feel about themselves and cheating men and all is well. But of course there is no-one who wants to admit that the pope is even partly right. Certainly in the west it is not fashionable to link the religious to politics, only if you are a weirdo like Bush. Although it seems like we should to tackle aids in Africa.